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Chapter 1
Changing Concepts of Intimacy in Psychoanalytic Practice
There is presently considerable debate among psychoanalysts about the amount of patient–therapist interaction permissible and, indeed, requisite to the successful outcome of the therapeutic endeavor. Although there has been a decided consensual shift in the direction of more active interaction, less “blank screen” participation, it has not been continuous, harmonious, or without acrimony. The strictly structured, anonymous therapist, the various interpersonal perspectives, the encounter therapist, and finally the evangelistic laying-on-of-hands (and, sometimes, taking-off-of-pants) therapists constitute a bumpy continuum, each station of which accuses the next most active of apostasy and self-indulgence. As in all wars, right is always on our side in the pursuit of the Holy Grail of intimacy, that special dimension of relatedness which most defines the climate of psychoanalytic change.
Intimacy, in this sense, may be considered the ambiance of engagement or closeness between therapist and patient which characterizes the “positive therapeutic alliance”—that state of good intent and hard work without which no degree of virtuosity nor depth of experience of the therapist can prevail. The concept, intimacy, unfortunately, denotes a very ambiguous felt state, difficult to formulate and, even more confusing, undergoing a continuous shift in its meaning. It is a lexical bridge; that is, a constant term used to span a concept diachronically changing in its historical meaning and referents.
It is considerably more parsimonious to invent a new vocabulary to describe a new theoretical set: This is what Harry Stack Sullivan did in his interpersonal theory. “Parataxis” replaces “distortion”; it is not a conceit to invoke a new lexicon, rather it describes a subtly changed theoretical perspective, consistent with the contemporary scientific paradigm. Sullivan’s model, consonant with his times, was communication theory, and many present theorists have gone on to general systems theory in an effort to keep the language and the theoretical model coeval. This is in the “scientific” tradition.1
There is, however, a more venerable and scholarly model in which one retains the traditional language but, by tacit agreement, the consensual meaning of the words is changed. One can expand the meaning to encompass more contemporary concepts, or, in some cases, the meaning of the word is actually inverted and takes on the opposite of its original sense. This form of lexical evolution, motivated by respect for one’s elders, serves to perpetuate tradition, establishes continuity, whilst permitting sufficient leeway to absorb novelty and change. Thus, some present-day analysts hold to the concept of “countertransference,” but mean something entirely different than did Freud; some use Sullivanian terms like “prototaxic” but have bent Sullivan’s original meaning. Yet, whatever their tradition, they may be a good deal more alike than different in their therapeutic practice. Contemporaneous therapists sometimes make strange bedfellows; yet a Freudian and a Sullivanian, both in New York in the mid-seventies, may have more in common with each other than with their own theoretical progenitors or even their contemporary cotheorists in Paris or Rio de Janeiro.
Intimacy, then, is a venerable word with a long history of changing meaning. Etymologically, it derives from the Latin, intimus, most within. In its earlier literary usage, it described the most private and unrevealed parts of the person, as in, “I did not dare reveal my most intimate thoughts and feelings.…” Intimacy is, in this sense, a willingness to expose one’s private inner self. It is not a concept of a process between people: the complex representation of mutual relatedness that it later became. One could, after all, as well expose one’s intimate undergarments as one’s intimate feelings. Over the seven decades of psychoanalytic development, there has occurred an inversion of the original meaning, from something inside to something outside, from most inner to most in-between, from a statement of location to a statement of process, from an essentially intrapsychic concept to an essentially interpersonal one.
This shift from inner to interpersonal space is part of a total shift in the underlying model of society from Freud’s day to ours. All the manifestations of a society—its science, its arts, its pop culture—reflect an underlying paradigm, a pervasive, subliminal sense of “how things are.” Freud worked within a cultural continuum that began with the Renaissance and ended with World War II. It was a period dominated by the model of self-contained, self-perpetuating mechanisms. The Newtonian model of the Work Machine dominated physics. People were thought of, in the scientific model, as self-contained and self-energized clockwork mechanisms. Correspondingly, the concept of a private self dominated social thinking. The author Joyce Carol Oates (quoted in Bedient, 1973) has called this the “renaissance ideal of a separate I … the paranoid protagonist in a drama staged between itself and everything else” (p. 1). It is paranoid in its self-reference, self-absorption, and in its goal: the grandiose renaissance ideal of perfectibility of the self and of society.
This is the key word: perfectibility. Its moral analog is sincerity, which etymologically derives from the Latin, sincerus, clean, pure, without decay. The concept of a private self, an intrapsychic self, self-contained, and potentially perfectible permeates early psychoanalytic thinking.2 Psychoanalysts required of the patient and the therapist sincerity in its developmental guise, maturity. Transference and countertransference represented distortions, imperfections, insincerities in the relationship. Sincerity, one must emphasize, did not signify to mean well, to be well intentioned, its present interpersonal attribution. It meant to be free of stain, pure. It has undergone the same transformation, over time, as has intimacy. From an intrapsychic attribute, it has come to mean an attitude about relationship. In its earlier psychoanalytic sense, it meant to perfect oneself, to cleanse oneself of neurotic intent. Some of us remember the days when psychiatric residents at the lunch table worried about their “latent homosexuality,” their “unconscious aggression.” Exposures of intimate fantasies and fears to one’s colleagues, sincere efforts to hear their criticism and psychoanalytic assessments reached Maoist proportions. We quickly learned that our colleagues tolerated these massive self-improvement sessions a good deal more tolerantly than our families. But certainly we wanted to be rid of our aggressions, our perversions, our imperfections, or, at least, to contain them in a web of conscious purpose. Let ego be where once was id. We never thought to come to terms with our polymorphous perverse nature, as does Norman Brown (1966), or, our epicene human heritage as now recommended by the ethologists and popular sexologists. We wanted to be better therapists, less distorted, to keep our unconscious out of the way of the patient. Our goal was health for the patient—and the therapist. We were, sad to say, very sincere, but not authentic!
Authenticity has become a cliché. Threadbare from overuse, shabby from misuse, it has lost its austerity. From the Greek, authentikes, it has two meanings: “one who does things himself,” and, oddly, the second meaning of “a murderer.” Why would the author of his own actions be a murderer? Julian Jaynes (1973), in his exegesis of the Iliad, suggests an answer. The Iliad is generally believed to have been an orally composed and communicated bardic composition beginning about 1200 B.C. and finally transcribed about 850 B.C. To quote Jaynes:
The astonishing thing about it is that there is no consciousness in the Iliad whatever. No one thinks, plans, or decides anything, strange and disturbing as that seems. … the characters in the Iliad have no consciousness at all. It is a behavioral world inhabited by noble automatons who know not what they do.
The Gods make the plans, direct their human agents. To defy the Gods, take destiny into one’s own hands, be the author of one’s own acts was unthinkable. A murder, then, is a killing without Olympian sanction: The ancient Greeks had no compunction whatever about wholesale slaughter, as long as they were following orders. This ancient curiosity of meaning has more relevance for present psychoanalytic doctrine than one might at first think. Authentic denotes an action in the interpersonal domain rather than an internal state of being as does sincere (in its original usage). The sincere man is without rottenness; the authentic man takes action, without sanction. The internalized effort to be one’s best is replaced by the interpersonal effort to be, with others, oneself with all its imperfections and shortcomings. Authenticity tries to match being and action; sincerity tries to perfect being and, consequently, action.
If the moral analog of sincerity is perfectibility, self-awareness is the analog of authenticity. Perfectibility, from this perspective, is seen as grandiose and even potentially malevolent. The meaning of transference and countertransference changes from attention to oneself or the other to attention to one’s impact on the other. Transference becomes a response to the therapist and countertransference a response to the patient. The issue of distortion drops away. Rather than decontaminating the relationship, the effort becomes to experience it without mystification, to see it as it is, without trying to change or improve it, paradoxical as that may sound. From the “you must learn how not to distort me” of early sincerity to the “you must learn, with the aid of my consensual validation, how to distinguish distortion and truth” of early Sullivan, one goes to the “you must learn to use as authentic and real whatever your response to me is. It is a reflection of who we are together, what it is like to experience each other frankly, with awareness and without the pressure to change it into something else or something better.”
This sounds dangerously like sanction for any acting out or impulsivity. But there is a Taoist paradox implicit. The sincere man believing in his goodness and his intentions to help may be less effective than the authentic man who must act without sanction or conviction about his rightness or his good intentions; he cannot be sure that what he feels or does is correct, acceptable, or even appropriate. Does one act out of true concern, anxiety, unconscious destructiveness? It cannot be known at the time of the action. The truth of the action lies in the patient’s response to it; that is, the truth is interactional. Or, to put it another way, the meaning of an act lies in its consequences. This is a line of thought with which Western mystics and Eastern philosophers are quite cognizant and comfortable. The Tao (English, 1972) puts it rather neatly!
A truly good man is not aware of his goodness and is therefore good.
A foolish man tries to be good, and is therefore not good.
An authentic act can be even catastrophic or evil in its effect. To propose, as so many glibly do, that to be “authentic” is to do whatever one wishes in therapy because what is “spontaneous” must be good (if one is sincere) is naive and simplistic. Sincere good intentions are no absolution for a destructive interaction. Thus, the strongest restraint against acting out is a reasonable humility about the limits of one’s own authenticity. To believe that one can be wonderfully authentic is to be sincere, to convert the concept into an act of goodness. To quote the Tao again (English, 1972): “When kindness and morality arise, the great pretense begins.” The same issue of paradoxical intent arises from the wish to change or cure the patient. An interpretation that intends to change the patient cannot be authentic. It tells him who he is, what he does wrong, or could do better. But it is instrumental. To author one’s own communications is to talk out of oneself, without intent. The effect of an authentic communication is therefore always unpredictable.
This may all seem quite disorienting but it has its clinical relevance. We have gone from the private self to the social self, from sincerity to authenticity, from the pursuit of perfection in oneself and the other, that has characterized romantic love to Fritz Perls: “You do your thing, and I’ll do my thing and if we do it together so much the better.” It does not sound classically intimate, but it may have its rewards. In authentic love, one need not strive for perfection, to be more than one is. Intimacy has now become an openness to the other person as he is. One must, parenthetically, take care to distinguish intimacy and closeness, used as a synonym. One can feel very close to people one knows very little about: A shared danger or excitement can create that. Intimacy must involve some process of engagement rather than simply a feeling state.
The intimacy that results from an authentic engagement with the patient requires, then, two precepts. First, the perspectivistic reality of the patient’s world must be recognized as valid and, second, the therapist must not use himself as a tool to lever the patient into change. Attempts to “use” one’s own participation, one’s own reactions to the patient, are transformed into sincere manipulations if the intent is to extract change. Interpretation, the primal tool of psychoanalysis, also changes in its usage. There are two dictionary meanings to “interpret”: The first is to explain, make the meaning clear to another; the second is to have or show one’s own understanding of the meaning (Webster’s New World Dictionary, 1956). The former belongs to the intrapsychic mode: One shows the patient his own most inside operations. The latter belongs to the interpersonal or transactional mode: One communicates one’s own melody of participation with the patient. The first is an interpretation of content; the last, an interpretation of process. All content (dynamic) interpretations appeal to the patient’s private self. They say, “You are … you feel … you do.” One can often observe, in a taped therapy session, that the therapist’s efforts to give the patient understanding of his dynamics comes just at the point in the interpersonal process of the session that the therapist has become anxious or invaded and is pushing the patient away. The content may be quite correct, the conscious intent impeccable, but the effect is to distance and subvert the exchange. Then, when the patient becomes angry or morose, we inform him that he is resisting an anxiety-laden truth. Count Alfred Korzybski (1933) saw this first, long ago, when, in General Semantics, he insisted that all levels of abstraction of interpersonal discourse arose from anxiety. The more uncomfortable one was, the more one abstracted or reified the other.
All psychodynamic interpretations, just as all metapsychologies, become, in the end, acts of countertransference; an extreme claim, but one more true than otherwise. This is not to say that dynamic interpretations cannot be useful. But they are not primarily therapeutic. After the fact, after the experience of patient and therapist has been validated, a content interpretation has the value of supplying the patient with a coherent myth, an armature on which to hang the story. That myth can be Freudian, Sullivanian, Jungian; its value is essentially shamanistic. It supplies the patient with a culturally accredited story that he and the therapist can use to talk about their experience with each other and with the outside world.3
One must consider that, from this somewhat extreme position, the psychoanalytic process may be self-destructing. It might swallow itself and disappear. If the sincere wish to change is replaced by the authentic wish to be oneself, what need is there for the therapist? It reminds one of the Evil Duke in Thurber’s Thirteen Clocks (1950), who was wont to say with a degree of complacence, that we all have our shortcomings and his was being Evil. Authenticity does not preclude being evil. I think that is the patient’s option. We have some need for misanthropes and outsiders. Moreover, one decade’s evil is the next decade’s indulgence; one need only examine the range of delights offered in one modern sex manual, The Joy of Sex (Comfort, 1972), to realize that it is blandly espousing activities that in earlier times would have gotten one jailed, shunned, cashiered, or burned at the stake. Psychoanalysts are as time-bound and immersed in their own culture as most; and our concepts of cure and mental health may be radically different in the future. The patient need not embrace the therapist’s cure any more than the liberated child his parent’s goals or expectations.
What is the function of the therapist if his goal is not to influence the patient, to change him? The therapist’s function develops naturally from one’s concept of how and why the therapeutic encounter works. I do not think it works out of the personal charisma or goodness of the therapist. Although that kind of encounter can be immensely helpful, it is not the primary aegis of psychoanalysis. We have, most of us, neither the temperament nor the resources to be gurus. I suspect the therapy works, not because of any communication the therapist makes, as we ordinarily think of communication as transmission of information across an interpersonal space. It may, as Tony Schwartz (1973) has suggeste...
